Healthcare Provider Details

I. General information

NPI: 1396888574
Provider Name (Legal Business Name): GREENE COUNTY SKILLS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 BOB SMITH BLVD
GREENEVILLE TN
37745-4223
US

IV. Provider business mailing address

130 BOB SMITH BLVD
GREENEVILLE TN
37745-4223
US

V. Phone/Fax

Practice location:
  • Phone: 423-798-7100
  • Fax: 423-798-7146
Mailing address:
  • Phone: 423-798-7100
  • Fax: 423-798-7150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberL 3(20)4M6-056-1334
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JIM D. GILLEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 423-798-7100